Healthcare Provider Details

I. General information

NPI: 1083677447
Provider Name (Legal Business Name): MARGIE M GODFREY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 UNA AVE.
CATHLAMET WA
98612
US

IV. Provider business mailing address

335 UNA AVE.
CATHLAMET WA
98612
US

V. Phone/Fax

Practice location:
  • Phone: 360-795-3201
  • Fax: 360-795-3209
Mailing address:
  • Phone: 360-795-3201
  • Fax: 360-795-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30001050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: